Several months ago, when the patient support group that I attend first began discussing Borrelia miyamotoi, a Google search (or Bing…whatever…) for those two odd words yeilded very little. Now, after the publishing of a few key papers in the New England Journal of Medicine, every major news outlet seems to be aware of this “new” Borrelia.

From a scientific perspective, Borrelia miyamotoi is interesting because it challenges a dichotomy that was established by researchers of tick-borne infectious diseases. When I first started reading about the Borrelia genus, I learned that Borrelia species could be sorted into two major categories: the Lyme disease-like group and the relapsing fever group. That is, Borrelia species like B. burgdorferi, B. afzelli, and B. garinii–which are genetically more similar, are carried by hard-bodied ticks, and cause the same pattern of symptoms (rash, joint pain, fatigue–were put in one group. Other species, like B. hermsii and B. parkeri–which differ genetically from these Lyme-like bacteria, are carried by soft-bodied ticks, and all cause relapsing fever symptoms–were put in the other group. One group for Lyme-like illness. Another group for relapsing fever-like illness. One group for hard-bodied ticks. Another group for soft-bodied ticks. The dichotomy is so clear that the ticks are sometimes referred to as “Lyme disease ticks” and “relapsing fever ticks.”

The funny thing about dichotomies is that they only create the illusion of two distinct categories. The reality is far more messy and characterized by shades of grey. Enter Borrelia miyamotoi. According to its genetics, it should go in the relapsing fever group, but it’s transmitted by the same hard-bodied ticks that carry Lyme disease. According to its symptoms, it falls somewhere in the middle. About 10% of people get a rash, like with Lyme disease, while others don’t. Some people get relapsing fevers, while others don’t. It’s all so very confusing!

As usual, both the researchers and the news media seem to be trying to downplay this. Some are unwittingly obscuring the issue altogether. “Paging Dr. House: There [sic] a new tick-transmitted spirochete in town…” writes Melissa Healey of the L.A. Times. “The New England Journal of Medicine on Thursday published two reports documenting its arrival on U.S. shores.” As if the bacteria hopped on a boat from Russia, and that’s how it got here! Forget the strong possibility that it was here all along and our scientists just failed to detect it. Forget the possibility that the countless numbers of people who tested negative for Lyme disease and were denied treatment could in fact have this similar infection.

Dr. Peter Krause, lead author on the NEJM study, says (in a video for Yale News) he doesn’t think people should panic about Borrelia miyamotoi. At the same time, he admits that this is an infection that is affecting people in both the eastern and western United States–not to mention people in Europe and Asia. “We expect this disease to be found everywhere the deer tick is found,” he states. So don’t panic, but it’s everywhere.

Okay, so Dr. Krause is right when he says people shouldn’t panic, but that doesn’t mean that we shouldn’t learn more about this new–or not so new, as the case may be–infection, especially since many of us could have it right now. Here are nine things I think you should know about Borrelia miyamotoi.

1. Symptoms: Borrelia miyamotoi causes symptoms of tick-borne relapsing fever (TBRF), an illness often misdiagnosed as Lyme disease, or not diagnosed at all. Tick-borne relapsing fever, when left untreated, has some symptom overlap with Lyme: arthralgias, myalgias, chronic fatigue, and cognitive problems; however, it differs from Lyme disease in that most patients with TBRF get repeated episodes of fever, and they don’t get erythema chronicum migrans (EM), the “classic Lyme” bull’s-eye rash. We can guess that the long-term effects of B. miyamotoi infection are similar to those of other Borrelia infections, even if researchers are reluctant to admit it. Dr. Peter Krause, one of the authors of the study published in the January 17 issue of the New England Journal of Medicine, told the L.A. Times: “This is a very new disease, but none of the patients have had this long-term [neurological] trouble or other long-term symptoms,[…] it’s possible that we just haven’t seen it yet.” Long-term neurological problems from a disease that most doctors didn’t know existed until a few months ago? I’d say it’s very possible.

2. Transmission: Borrelia miyamotoi is transmitted to humans from the bites of hard-bodied ticks. Examples of these ticks include Ixodes scapularis (deer tick), Ixodes pacificus (western blacklegged tick), Ixodes ricinus (castor bean tick), and Ixodes persulcatus (taiga tick). (The first two tick species listed are common in North America, and the second two are found in Europe and Asia.)

3. Why you’re just hearing about it now: The B. miyamotoi bacterium was discovered in ticks and mice in Japan back in 1995. (It’s named after Japanese entomologist Kenji Miyamoto, who first isolated the bacterium.) In 2001, Dr. Durland Fish discovered B. miyamotoi in ticks in Connecticut, but according to a 2011 New York Times report, he “was repeatedly refused a study grant [from NIH] until the Russians proved it caused illness.” In 2011, Russian scientists, in collaboration with the Yale team that included Krause and Fish, published research that showed that B. miyamotoi infects humans. The patients in the 2011 study were in Russia, so B. miyamotoi didn’t really come on the radar for U.S. doctors until January 2013, when a study on U.S. patients was published by Krause and colleagues in the New England Journal of Medicine.

4. Testing: To my knowledge, there is currently no commercially-available test for B. miyamotoi, be it PCR, IFA, or Western Blot. B. miyamotoi has been detected using assays (tests) that were developed by university researchers in order to study the bacterium. That means, unless your doctor is at Yale or another large institution, it’s not likely that he or she has access to a test for B. miyamotoi. So if you suspect you may be infected, what can you do? That brings me to my next point.

5.People with B. miyamotoi infection are likely to test negative for B. burgdorferi (Lyme disease), unless they also happen to be infected with B. burgdorferi. Doctors who are only screening patients for Lyme disease are not going to catch all of the other Borrelia infections, like B. miyamotoi.

6. Genetically, B. miyamotoi is more similar to other bacteria that cause TBRF, like Borrelia hermsii. Therefore, people with B. miyamotoi infection may test positive for B. hermsii, another relapsing fever spirochete.

7.As with any infection, B. miyamotoi infection can be more serious in the elderly and in patients with compromised immune systems. If you or a family member is denied treatment, especially in the case of severe or life-threatening symptoms (like high fever), my advice would be to go to a tertiary care center (like a university hospital) and ask to be tested for B. miyamotoi. At the very least, doctors at a research hospital should be able to do a blood smear to look for spirochetes (Borrelia). PCR and antibody tests may also be available.

8.Treatment: B. miyamotoi probably responds in a similar way to antibiotics as other Borrelia like B. hermsii and B. burgdorferi. Researchers claim that it can be treated with a few weeks of oral antibiotics, but that is probably only for mild, acute cases. My guess (as a non-medical-professional) is that B. miyamotoi is just as resilient as its Borrelia cousins and requires 4-6 weeks of daily IV antibiotics. If you’re new to this blog, you might be interested in reading about my experience being treated with IV antibiotics for B. hermsii (relapsing fever).

Most people think you have to be hiking around in the woods to pick up a tick. In reality, ticks are a lot closer than you think. Here are four (possibly surprising) places where ticks hang out:

1. In your un-mown lawn. Ticks like to hide in vegetation to keep from drying out. Vegetation includes tall grasses, so don’t get lazy on the lawn upkeep!

2. In piles of fallen leaves. Yes, leaves are fun to jump in, and yes, the crunchy sound they make when you walk over them is lovely, but you (or your pet) could also be picking up ticks from leaf litter, so rake ’em up!

Ticks feed on and pick up diseases from mice. Image via tickencounter.org

3. Anywhere mice or other rodents live. This includes wood piles, rock walls, crawl spaces, ground covers, abandoned vehicles, garbage, bushes, and palm trees. Mice also like to eat fallen fruit, so if you have fruit trees, be sure to dispose of any fruit that falls. If you have mice or rats in your home, chances are you have ticks, too. Here’s a more detailed list of mouse hiding places and what you can do to keep them away from your yard and house.

They collected ticks (some of which tested positive for Borrelia) from various areas in Berkeley’s Tilden Regional Park and found as many on wood surfaces as in leaf litter. If you’re planning on a day in the park, I recommend long pants and repellent with Permethrin.

If you’re spending time outdoors, it’s a good idea to check yourself for ticks as soon as you come inside. The University of Rhode Island’s Tick Encounter Resource Center has a great multimedia tool, the Tick Bite Locator, which suggests common places to check for ticks. They also have images of a variety of disease-carrying ticks (although the soft-bodied ones are missing) at different life stages.

We all know (I hope) that an ever-increasing deer population means an ever-increasing tick population. We may not be able to stop the deer from multiplying (although I hear some are trying with bowhunting), but can we stop the ticks?

Fairfax Wildlife Biologist Vicky Monroe displays the day-glo pink pesticide that will show up on deer and any other animal who visits the county’s new feeders. Image via The Washington Post.

A March 26 article in the Washington Post describes a study the Fairfax County (Virginia) Wildlife Biologist’s Office (in collaboration with the county’s Disease Carrying Insects Program) is undertaking in which deer are attracted to feeders with corn and simultaneously treated with permethrin, a tick-killing pesticide. The twist? The pesticide has been dyed pink to allow for easier tracking of the deer. Fairfax County residents can expect to see not only pink deer, but also squirrels, raccoons, birds, and any other fauna that stop by for a snack.

How will this aid research on and prevention of tick-borne illness? Washington Post’s Tom Jackman explains:

On a couple of days every other month for the next three years, the pink deer will be harvested (or “killed,” in non-wildlife biologist terms) and autopsied. Deer organs will be tested and the remaining ticks will be sent to a lab for detailed analysis

Thus, the pink deer study will help the Fairfax County Wildlife Biologist’s office determine how effective the feeder-application of the pesticide is in killing disease-carrying ticks on the deer.

The study is costing the Fairfax County Health Department $380,000. For those in the county who have been affected by tick-borne infectious diseases (TBIDs), I’m sure this is not too high a price.

Would you support programs like this in your community? What is your county doing to control the vector population and prevent TBIDs?

9:24 When she says she is positive for 4 strains of Lyme, I assume that she means that 4 bands (out of 10) on her western blot were reactive (positive). The word “strain” is misleading because it makes it sound like she has 4 different infections. Lyme Disease is caused by one species of bacteria named Borrelia burgdorferi. There are, however, other bacteria in the Borrelia genus that cause Lyme-like symptoms–B. hermsii being one of them.

9:41 She has a PICC line, which is more convenient for the doctor because she doesn’t have to stick her with a needle every day, but the risk of secondary infection is much higher than getting a new IV in the hand everyday.

9:45 Five IVs a DAY?!?! WHY?

9:52 Why is she being treated with IV Zithromax and not Ceftriaxone? (Zithromax/azithromycin is what you take orally when you have Strep throat.) I guess this explains the 5 IVs per day. Maybe if they used the right drug, she could cut back to one IV per day.

10:16 That freaks me out that she’s speeding up her own drip. Only the doctor is supposed to do that! (If the drip goes too fast, you can have a nasty adverse reaction.)

11:57 I wonder which tests she got, and in what order.

14:30 Here’s Dr. Auwaerter’s CV, if you’re curious. Scroll down to the publications.

15:08 You can read the text of the monkey study Dr. Bhakta alludes to here. BTW, Dr. Bhakta’s residencies were in Respiratory Therapy and Anesthesiology. She is not board certified in California. To read more about board certification, go here.

Looking forward to spring? I’ve really been enjoying the extra daylight and walks with my dog, Lucy, after dinner, and it was so nice on Easter to be able to wear a dress without my legs getting cold!

Lucy is ready for a walk.

Nice weather, however, comes at a price. An article published last month in the Wall Street Journal explains how warming weather will contribute to an increase in tick population (and likely an increase in the number of tick-borne infections) this spring. You can (and should) read the full article here.

Here’s an interesting tidbit about a study the Centers for Disease Control are doing:

The CDC is conducting the first study of its kind to determine whether spraying the yard for ticks can not only kill pests, but also reduce human disease. Participating households agreed to be randomly assigned a single spray with a common pesticide, bifenthrin, or one that contained water, without knowing which they would receive.

Paul Mead, chief of epidemiology and surveillance activity at CDC’s bacterial-illness branch, says preliminary results from about 1,500 households indicate that a spray reduced the tick population by 60%.

“But there was far less of a reduction in tick encounters and illness,” indicating that even a sharp drop in tick populations leaves infected ones behind. “We may have to completely wipe out ticks to get an effect on human illness,” he says. The CDC is enrolling households for a second arm of the study and expects final results late in the fall. Organic repellents such as Alaska cedar are also being tested in other studies.

The article includes an interactive graphic with some suggestions for how to avoid tick bites in your backyard: